The Art of Improvisation

03Oct

In Haiti, you learn to work with what you have.

Often, that isn’t much. Things that Team Broken Earth has had learned to work without today: running water (for a brief time); an x-ray machine and, now, the intraoperative x-ray, as well (indefinitely); some blood tests (recurring); sufficient beds for patients and volunteers (recurring); Internet access (periodically); pants for little children who wet themselves in the recovery room post-surgery.

The list goes on.

Doctors and nurses say to me repeatedly that you have to practice medicine differently here. Never unsafely but always differently. You learn to rely on what’s available and not what you’d like to have available.

For three months, it’s been the only x-ray machine available at the hospital because the standard x-ray machine isn’t working. A new x-ray was supposed to be installed the day before the Team Broken Earth group left Calgary. The machine arrived but it’s out-of-date and no one here knows how to get it working.

Here, members of Team Broken Earth have to consider factors that they’d never think about in Canada. How do you keep a wound clean if you have no roof over your head? What do you do with body parts after surgery as the family sometimes asks to see what has been removed? What do you do with patients when you have no beds left on site but the patients are afraid to travel home because it’s dark and the streets are unsafe?

Today, a 26-year-old Albino Haitian woman arrived at the hospital. Skinny and scared, she’s quite unforgettable. She has severe melanoma – the result of years of her unbearable pale skin broiling under the relentless Haitian sun. Her white skin is now dotted with large black asymmetrical spots, an effect more like the markings on a leopard than moles on a human. But what’s brought her in now is the massive golf ball-sized lump that protrudes above her left eye. It causes her endless pain, especially in the hottest hours of the day, she says. She winces as the surgeon gently palpates the edges of the lump. Its top caves inward like a crater; the edges white, the center black.

The surgeons want to operate on her tomorrow. The OR suites are booked today. But this woman and her husband have travelled more than an hour to get to the city. They are afraid to travel at night. Our surgeons are afraid that if they book her for tomorrow, she simply won’t come back. That happens all too often.

There’s no bed to keep her here tonight in advance of tomorrow’s surgery. So they’ve decided to operate as soon as they can tonight. One of the surgeons is napping on a chair in the hallway right now as there’s no telling when that will happen.

In the meantime, I’m going back to the PICU to hang out with a three-year-old boy. He learned the art of the selfie earlier today with our nurses and he can’t get enough of watching himself grin for a camera.